More NPs and PAs are choosing to work on as locum tenens, new survey says.
Most locum tenens physicians and other advanced practice providers working as temporary hires were not deterred by the threat of COVID-19, according to a new survey.
Nearly three-fourths (71%) of locum tenens physicians, nurse practitioners (NPs), physician assistants (PAs), and certified registered nurse anesthetists (CRNAs), have treated COVID-19 patients, suggesting that locum tenens providers have played an important role in providing care during the pandemic, according to the survey, conducted by Staff Care, a national physician staffing firm and a subsidiary of AMN Healthcare.
The survey examines the practice patterns of healthcare providers who work as locum tenens (Latin for “to hold a place”) to fill temporary assignments that may last from one day to more than one year.
In the past year, when COVID-19 has filled health systems and hospitals, only 5% of the locum tenens providers said they stopped working due to the virus, while 23% reduced the number of assignments they accepted.
However, most (55%) said the virus did not cause them to change the number of assignments they accepted, and 18% said they increased the number of assignments they accepted because of the virus.
"Locum tenens physicians and other locum tenens providers have been widely used for years to fill gaps caused a shortage of healthcare professionals," said Jeff Decker, Staff Care president. "Having a mobile resource of providers that healthcare facilities can draw on can be particularly useful when healthcare challenges spike, as they have with Covid-19."
Freedom and Flexibility
Most providers surveyed identified freedom and flexibility (81%) as the primary benefit of locum tenens work, followed by per diem pay rates (55%) and the opportunity to travel (50%). Ninety percent said that locum tenens is as satisfying or more satisfying than permanent practice, while only 10% said it is less satisfying.
"Many physicians and other providers are burned out by the administrative and reimbursement hassles that come with medical practice today," Decker said. "Locum tenens allows for a comparative degree of freedom and the ability to focus on treating patients, which is what healthcare providers enjoy the most."
There are other benefits: 66% indicated that working as a locum has expanded their understanding of different healthcare delivery systems; 56% say it has expanded their professional networks; and 49% say it has provided them with positive travel experiences.
Though locum tenens providers were once a rarity at hospitals, they are common today, Decker said, with about 52,000 physicians working as locum tenens during a year, Staff Care estimates.
Most of those surveyed said that they are accepted at their temporary jobs: 90% said they are accepted by colleagues; 82% said they are accepted by administrators; and 96% said they are accepted by patients.
More locum tenens advanced practitioners
More NPs and PAs are choosing to work as locum tenens, which physicians have been doing for many years, the survey shows.
Sixteen percent of providers who responded to the survey were either NPs or PAs, up from 8% in 2016. The growing number of NPs and PAs working as locums indicates shortages may be developing in these professions, Decker said.
"As we have seen with nurses and physicians, when shortages occur, temporary providers are used to fill gaps," he said. "This is now happening with NPs, PAs, and other advanced practice professionals."
UW Health's mid-shift huddles produce better patient care, communication, and collaboration, nurse leader says.
Mid-shift huddling at University of Wisconsin Health has resulted in better care for high fall-risk patients, increased training in patient handling, and better teamwork, says a nurse leader there.
"The dedicated time for information-sharing and checking in with the entire team better equips the team with needed information to provide safe patient care and allows the team to support each other," says Sara Schoen, MSN, RN, CCRN, a nurse manager at UW Health in Madison, Wisconsin.
Staff responsiveness was up nearly 6 points in the Hospital Consumer Assessment of Healthcare Providers andSystems (HCAHPS) report
Safety scores improved by 13%
Hand hygiene compliance increased and remained above 90%
Patient falls declined significantly, with one unit achieving zero patient falls over five months.
When UW Health implemented mid-shift huddles about four years ago, the initial goal was on patient safety, but that has expanded to include informational content, as well, Schoen says.
Schoen shared with HealthLeaders the structure and benefits of the mid-shift huddles, which occur three times per day—once per shift— at 10:30 a.m., at 5 p.m., and 3 a.m.
This transcript has been edited for clarity and brevity.
HealthLeaders: How are mid-shift huddles different than those held at the beginning of the shift?
Sara Schoen: On my unit, huddles at change of shift are a high-level overview of what staff need to know to successfully start their shift, such as unit status (census, open beds, admits/discharges), staffing, and safety concerns (code status, high fall-risk patients/recent falls, patients of concern).
We also develop a WINK—What INeed to Know—each day that is read during this huddle over all shift changes. These cover quick unit or organizational updates that don't need much discussion but are helpful to know prior to starting a shift, such as updates to the visitor policy, PPE changes, or workflow updates related to COVID.
The care team leader facilitates shift-change huddles, and they are held at the nurses' station on the unit so all staff from the off-going and oncoming shift can attend the huddle. The goal of the shift-change huddles, which are to last no more than five minutes, is to set the team up with the needed information to successfully start their shift.
With mid-shift huddles, we go into more detail regarding unit status, and we also include more detail on our high fall-risk patients, cover informational and educational content, and check in with each staff member to redistribute resources if anyone needs help. The care team leader leads these huddles as well, and they are attended by the staff working that shift. Mid-shift huddles tend to last closer to 15 minutes and cover topics that need more in-depth discussion, such as a practice changes, lessons learned from recent healthcare-associated infections events on the unit, or educational content.
HL: What does the educational content consist of?
Schoen: Topics over the past couple weeks have included a refresher on use of nasogastric tubes, a brief overview of interventions for delirium from our geriatric [clinical nurse specialist] (CNS), lessons learned from a recent hospital-acquired pressure injury event on the unit, upcoming changes to the annual performance review process, and some diabetes updates from our diabetes resource nurse.
We have also used huddles to do some fun activities. In partnership with our psychiatric liaison CNS, we had our team complete eight weeks of content on different mindfulness/resiliency topics. We were able to review this content again for a few weeks last fall when our COVID census was increasing and feelings of stress on the unit were high.
Another fun activity we did was having each staff member determine their Myers-Briggs personality type; we then completed a week of different activities during mid-shift huddles using the various personality types to promote teambuilding.
HL: How have the mid-shift huddles benefited your nurses and your patients?
Schoen: A more recent addition to our mid-shift huddles is a discussion of the three patients at highest risk for falling, which are identified during huddle by the staff each shift. The RN and NA caring for each of these three patients are asked to share why the patient is at high risk for falling, any helpful interventions that all staff should know, how the patients mobilize, and what the mobility plan is for each patient for the day, as we really try to focus on mobility as an intervention for falls.
Knowing how each of these patients move is helpful to all staff when answering call lights or bed/chair alarms from these patients, and staff are better aware of which patients could use an extra set of eyes or additional assistance during the shift. Staff have been able to better assist each other with patient care after hearing this information, and all staff are better equipped to play a role in fall prevention on the unit.
We recently used mid-shift huddles to do 1:1 education with our staff on specific safe patient-handling devices with the goal of improving both staff and patient safety with transfers. This training showed an increase in staff use of this equipment, which benefitted both staff and patients. It would have been challenging to provide this education outside of scheduled shifts to the entire team, but using the dedicated time during mid-shift huddles allowed us to provide the education quickly and efficiently.
Ultimately, the dedicated time for information-sharing and checking in with the entire team better equips the team with needed information to provide safe patient care and allows the team to support each other through the huddle structure we have in place.
HL: What do your nurses think of the mid-shift huddles?
Schoen: Our team appreciates the dedicated time to check in with each staff member, as well as do a mid-shift check-in on the overall status of the unit. Staff also appreciate the time for conversation surrounding the topics covered during huddle rather than having to read the updates via email.
The biggest challenge we have is time—we have to be very conscious of the amount of content we cover during huddles to ensure staff can dedicate the time to attend huddle and not feel like they are being taken away from patient care.
HL: What would you say to other nurse leaders who might not see the benefit of mid-shift huddles?
Schoen: Changes on the unit come quickly, and it isn't efficient for the Care Team leader to communicate updates with each team member individually. Mid-shift huddles provide a venue for all staff to get an up-to-date status of the unit in real time.
In these fast-paced environments, it's very easy to lose sight of what's happening elsewhere on the unit when you're busy with your own work, and mid-shift huddles allow the team to collaborate to redistribute workload and real-time problem solve if needed. The collaborative structure of mid-shift huddles empower the entire team to be leaders in addressing safety concerns and promoting teamwork on the unit.
Communication of organizational updates, practice changes, or educational content through mid-shift huddles is a secondary gain for leaders. As leaders, we are continually challenged with finding new and creative ways of having real-time, efficient communication to ensure our teams are prepared with the needed information to provide safe and high-quality patient care each shift.
Mid-shift huddles provide a perfect venue for that communication, as they allow for real-time communication as well as provide a venue for discussion among the team. We can quickly disseminate information or education as issues or updates arise rather than relying on staff members to find time to read an email or attend a staff meeting weeks after the information was needed.
NPs have proven their care is on par with physician care, Penn Nursing educator says.
Nurse practitioner Medicare reimbursement rates should be bumped up from 85% of the physician pay rate to the full 100% because of their proven ability to provide comparable care, says a new article in The Online Journal of Issues in Nursing.
"The COVID- 19 pandemic serendipitously led to the removal of many restrictions on NP practice, a positive change that needs to become permanent," Bischof says. "This is the time for NPs to seize the opportunity to work with MedPAC to achieve full reimbursement for care provided."
The article, Post COVID-19 Reimbursement Parity for Nurse Practitioners, summarizes the evolution of the practice of NPs and the rationale for reimbursement parity for nurse practitioners. She also outlines the potential benefits of providing NPs with 100% reimbursement, including incentivizing them to practice in primary care settings where there is a shortage.
Support for full practice authority is growing. The National Academy of Medicine released The Future of Nursing 2020-2030report last month recommending that nurses be allowed to "practice to the full extent of their education and training by removing barriers that prevent them from more fully addressing social needs and social determinants of health and improving health care access, quality, and value."
The report also suggests that federal authority should be used to supersede restrictive scope of practice state laws, the report says.
The American Medical Association and other physician groups, however, argue collaborations are needed for patient safety.
Bischof encourages nurse advocacy groups and researchers to direct future studies to investigate how full practice authority and the removal of practice barriers due to the COVID-19 pandemic have affected the level of care that NPs provide.
"Such studies can then be used to support further evolution of reimbursement policy" she says, "if NPs indeed produce an equal or better product than physicians."
New center builds on Columbia University School of Nursing's long-standing commitment to LGBTQ health.
A new center at Columbia University School of Nursing has been established to help eliminate health disparities among sexual and gender minority (SGM) populations.
The Center for Sexual and Gender Minority Health Research (CSGMHR) will use innovative methods to study health among SGM populations, as well as support nursing and interdisciplinary scholarly work focused on social justice and health equity among SGM populations, according to a press release.
"While recognition of LGBTQ people's unique needs is growing, we lack solid evidence on how marginalization, stigma, and discrimination impact health," says Tonda Hughes, PhD, executive director of the CSGMHR, associate dean of global health, and the Henrik H. Bendixen Professor at Columbia Nursing.
"The center will support rigorous interdisciplinary research on the social, political, and economic determinants of health for SGM populations," she adds, "which will, in turn, inform practice and form a knowledge base for interventions to address health disparities."
SGM individuals experience worse physical and mental health than their heterosexual peers and face an increased risk of cardiovascular disease, certain cancers, substance abuse disorders, depression, and suicidal behavior, research shows.
Lack of access for SGM people to respectful, affirmative health care is well documented. Many LGBTQ individuals report having experienced discrimination by clinicians, including outright refusal of medical care, surveys have found.
In the 2015 U.S. Transgender Survey, nearly one in four trans people reported not seeking necessary medical care because they feared being discriminated against.
One-third of those who saw a healthcare provider in the previous year reported having at least one negative experience related to being transgender, including being refused treatment, verbally harassed, or having to teach the provider about transgender people to get appropriate care, according to that survey.
In 2019, the school hosted the first National Nursing LGBTQ Health Summit to create a national health action plan to raise awareness of and improve LGBTQ health.
"Dr. Hughes and her colleagues are conducting ground-breaking research that will further Columbia Nursing’s commitment to health equity and social justice," says Lorraine Frazier, PhD, dean of Columbia University School of Nursing and the senior vice president of Columbia University Irving Medical Center. "Under her leadership, the center will train the next generation of researchers in this vital field and educate experienced investigators on the importance of SGM status for health."
The CSGMHR is funded by the Columbia University School of Nursing.
Live virtual training will help nurses who are suffering traumatic effects from working on the front lines of the COVID-19 pandemic.
A free live webinar addressing the risk of suicide among nurses will offer ways to overcome burnout and improve quality of life to nurses, nurse practitioners, clinical nurse specialists, nurse educators, and other healthcare professionals.
Suicide risk is significantly higher in the nursing population. Female nurses are roughly twice as likely to die by suicide than the general female population and 70% more likely than female physicians, according to a University of Michigan study that examined suicide among physicians and nurses.
Data for the study was gathered before the COVID-19 pandemic, which means those numbers likely are even higher now.
Though nurses have been hailed as heroes during the COVID-19 pandemic, they have endured overwhelming trauma, grief, and challenges, and though more hospitals are returning closer to normalcy, that doesn't mean the traumatic events have eased from their memories, says Stephanie L. Bunch, RN, MSN, ANP-C, PMHNP-C, who will be conducting the seminar.
"Maybe the difficult moments just keep replaying," she says. "You know something must change but you don’t know how to get started healing."
"The struggle of nurse suicide and burnout is real, and quite underplayed. Many nurses are struggling with mental health, but they're not talking about it," Bunch said in a press release. "If they do decide to share, they're reminded to 'practice self-care'—which is great—but many feel as though their struggles aren't being heard, and at this point self-care alone isn't enough."
The unresolved emotions can feel exhaustive, leaving many nurses feeling emotionally and physically drained, searching for answers that go well beyond self-care, she said.
"If we fail to recognize these feelings, they can lead to depression, anxiety, fatigue, somatic symptoms, and even nurse suicide," Bunch said.
The webinar will examine common risk factors, burnout/compassion fatigue, and trauma experienced from the pandemic, while providing strategies for solutions, such as showing nurses how to use their voice to address workplace concerns and how to initiate change on their unit.
Register for the webinar here. Registrants will be eligible to earn up to 1.5 ANCC-approved CE hours at no cost.
Those who can't attend the live webinar should register anyway, and they will have access to the video recording afterward to watch at a convenient time.
Virtual nursing model yields zero CAUTI levels, high patient engagement scores, and extra sets of hands for shift nurses.
MercyOne Des Moines' virtual nursing program was installed to offset nurse shortages and, when the pandemic hit, to protect staff and patients, but outcomes have yielded so much more: improved quality; decreased falls; decreased medication duplication; decreased missed care; and zero catheter-associated urinary tract infections (CAUTI) rates.
"What really was a welcome thing was our medical staff loved it," says Linda Goodwin, MSN, MBA, FACHE, senior vice president of clinical operations, integration, and innovation, who piloted the program in her former position as MercyOne's chief nursing executive (CNE).
Virtual nursing conveniently connects nurses, providers, specialists, and family members as needed; floor nurses receive extra help; physicians get fewer calls; patients receive quick, personalized service; the hospital earns high engagement scores; and nurse leaders are feeling less of the staffing shortage pinch, she says.
"It's speeding up care. It's preventing duplication of care," Goodwin says. "It's reducing time from order to care, and it's improving the quality patient-physician engagement."
Since the program started shortly before the 2020 pandemic hit, it has grown to 72 beds and eventually will broaden to the Iowa health system's rural affiliates and 44 hospitals.
How it works
Using videoconferencing technology and dedicated devices in each patient room, including a monitor, MercyOne's virtual nurses assist bedside nurses by monitoring the unit from a remote digital center.
The virtual nurse, who is responsible for 18 patients, participates in daily interdisciplinary rounds via teleconferencing, in which the patient's care team videoconferences into meetings, compares notes, and confers with each other, she says.
The virtual nurse then facilitates all care communications, such as calling for test or lab results, reviewing charts, handling discharge duties and anything else the care team needs, Goodwin says.
Dietary, care management, and pharmacy also are part of the growing virtual nursing program, she says.
"These pharmacists are taking medication reconciliation off the backs of nurses. They make sure there's no duplication of med orders, they stop a lot of errors, and they do all the patient education around new medications or diabetic education," Goodwin says. "They are a phenomenal piece of this team. It isn't just a nurse model anymore; it is a multidisciplinary model."
MercyOne's program also allows the patient's family to easily participate in care meetings with doctors and specialists as they explain the diagnosis and treatment, share test results, and discuss treatment options.
When it's time to discharge the patient, the family can log in to get discharge instructions and ask questions of a virtual pharmacist and other care team members to understand how to properly provide for the patient at home, she says.
Each patient's plan of care is top of mind in every round and every huddle, Goodwin says, which means if a patient wants something as simple as a chocolate malt, they immediately get a chocolate malt, ordered up by the virtual nurse.
"It's not delayed. It's not, "Oh, I'll put it on the list, and I'll call when I get back to the desk.' The virtual nurse can immediately deliver (on) those things, Goodwin says. "That's another reason it's so important to have them be free of any other responsibilities other than full focus on the patient."
Interestingly, the virtual nursing digital center is not onsite at MercyOne, but several miles away on the edge of downtown Des Moines, Goodwin says.
"One thing we learned," she says, "is to never place the unit close to the unit where virtual is being provided."
"You would think that's crazy, but what we found is nurses are who nurses are, and if they see that something's needed to be done quickly and the other nurse is too busy, they would leave the camera and go help," she says, "I said, 'No, we can't have that,' so we physically moved it off site and that has been very successful."
Why floor nurses like virtual help
While the virtual model is beneficial for units that may be short-staffed or have several newly graduated nurses, busy floor nurses taking care of five or six patients particularly welcome the assistance and support that virtual nurses provide because:
They see less harm to patients—falls, for example—because the virtual nurse has a constant eye on each patient. "Because floor nurses have such sick patients, it oftentimes takes a lot of their time, but they can be comforted by the fact that a virtual nurse is overseeing their patients," Goodwin says.
Virtual nurses can handle discharge duties. The virtual nurse knows the patient and the discharge plan of care. "They can arrange transportation with a social worker and never bother the nurse on the floor," Goodwin says.
They can handle challenging family dynamics. "Do you know how much time it takes for a floor nurse when there are dysfunctional families?" Goodwin says. "The virtual nurse takes that off their hands."
Floor nurses experience fewer interruptions. "Nurses get interrupted over and over and over and over and that causes them to miss many things they should be doing," she says.
Why patients like virtual nursing
Goodwin has queried MercyOne patients about their virtual nurse experience and most of them prefer it, she says.
"They will always say, 'I know what's happening; I'm not guessing why, and I don't have to delay and wait for the third or fourth consulting physician to give me the answers,'" she says.
Other feedback includes:
Patients like having questions answered immediately.
Patients find comfort and safety in knowing someone is right there if they need them.
Family can visit virtually any time they want and can also have questions answered quickly.
Skyrocketing patient engagement scores
Goodwin credits the program's success to the forward thinking of Kathleen Sanford, DBA, RN, now executive vice president and chief nursing executive (CNO) of CommonSpirit Health, of which MercyOne is a part.
"Way back in 2011, Kathy made a prediction that the nursing shortage was not going to end, and we would have to adopt new innovative approaches to providing nursing care," Goodwin says.
Inspired by Sanford's virtual nursing care model, Goodwin, who worked with Sanford in Denver at the time, put together her own model and soon relished the same results that MercyOne has experienced.
"The most remarkable finding was we had the highest patient engagement scores I've ever seen," Goodwin says. "We went from an average percentile ranking in the 60s to several months where we got 100% patient satisfaction on 'Would you recommend?' I've never seen it. Never, never seen it."
When Goodwin was recruited in 2018 to MercyOne to be SVP/chief operations officer and CNE, she immediately got to work on a virtual nursing program, launching it shortly before the COVID-19 pandemic hit.
The virtual model has become so favored at MercyOne that more nurses are requesting it, Goodwin says.
"The only limiting factor is getting virtual nurses hired," she says, "and then being able to spread it as quickly as we want."
The rules, set to be released Thursday, were expected to apply broadly to all workplaces and require workers to wear masks; however, the Biden administration decided to apply them only to healthcare workers, Labor Secretary Marty Walsh said, in announcing the decision today at a hearing of the House Committee on Education and Labor.
"OSHA has tailored a rule that focuses on healthcare, that science tells us that healthcare workers, particularly those who have come into regular contact with people either suspected of having or being treated for COVID-19, are most at risk," Walsh said.
NNU emphasized the importance of an enforceable mandatory standard for healthcare employers.
"This is still a dangerous and deadly pandemic," said NNU president Zenei Triunfo-Cortez, RN. "Americans continue to be infected and die. Nurses and other frontline caregivers remain in danger, especially with the pullback in safety measures across the country that will likely only increase the number of infections, hospitalizations, and deaths."
As of today, more than 400 RNs have died, among more than 3,800 healthcare worker deaths overall, according to NNU tracking data. However, the full accounting may never be known because complete data has not been collected, NNU said.
While the ETS is targeted to healthcare employers, NNU also supports stronger workplace pandemic safety measures for all workers, all patients, and all communities, Triunfo-Cortez said.
NNU has battled hospital employers from the pandemic's outset to ensure nurses have safe personal protective equipment and other infection control measures, the union said.
“An ETS is a major step toward requiring accountability for hospitals who consistently put their budget goals and profits," Triunfo-Cortez said, "over our health and safety."
The decrease may have led to as many as 29K COVID-19 deaths, new study suggests.
The decreased use of convalescent plasma to treat hospitalized COVID-19 patients might have led to more than 29,000 excess deaths during the winter surge, a new study suggests.
"Clinical trials of convalescent plasma use in COVID-19 have had mixed results, but other studies, including this one, have been consistent with the idea that it does reduce mortality," study senior author Arturo Casadevall, MD, PhD, Alfred and Jill Sommer Professor and Chair of the Department of Molecular Microbiology and Immunology at the Bloomberg School, said in a press release.
Hospitals began treating COVID-19 patients with convalescent plasma therapy—which uses antibody-rich blood from recovered COVID-19 patients—in summer 2020 when doctors were looking to identify treatments for the emerging disease.
The researchers compared the number of units of plasma distributed to U.S. hospitals from blood banks, on a per-patient basis, to the number of reported COVID-19 deaths per hospital admission across the country.
They found that while the total use of plasma peaked last December and January during the winter COVID-19 surge, the use per hospitalized patient peaked in early October 2020—just as deaths per COVID-19 hospital admission bottomed. Thereafter, in the wake of reports of negative results from clinical trials, use of plasma per hospitalized patient fell sharply—and deaths per COVID-19 hospital admission rose.
The researchers analyzed the relationship between these two datasets and found a strong negative correlation, with higher use rate being associated with lower mortality and vice versa. They also grouped periods of plasma use into five “quintile” groupings from lowest-use weeks to highest and found a graded relationship between less use and higher mortality.
A model the researchers generated to fit the data suggested that the COVID-19 case fatality rate decreased by 1.8 percentage points for every 10-percentage point increase in the rate of plasma use, according to the study.
That model implied that there would have been 29,018 fewer deaths from November 2020 to February 2021, if the peak use rate of early October had held. It also suggested that the use of plasma overall, as limited as it was, prevented about 95,000 deaths through early March of this year.
The researchers considered, but rejected, the possibility that other factors—changes in the average age of hospitalized patients and the emergence of new COVID-19 variants—could explain away the link between less plasma use and more mortality.
Regarding those clinical trials that found no benefit for plasma use, many of them had used plasma—mainly considered an antiviral treatment—relatively late in the course of COVID-19, when patients may have been too ill to benefit, and when the disease is driven mainly by immune-related responses rather than the coronavirus itself, the study says.
Convalescent plasma remains under FDA Emergent Use Authorization in the U.S., and is readily available, Casadevall says.
"We hope that physicians, policymakers, and regulators will consider the totality of the available evidence, including our findings," Casadevall says, "when making decisions about convalescent plasma use in individual COVID-19 patients."
With a newly awarded patent, the young nurse/inventor plans to strategically license her product so hospitals can save money, reduce waste, and 'hopefully save time for nurses.'
A new nursing graduate who noticed the waste from standard boxes of disposable gloves recently received a patent for an antimicrobial shield that adheres to the front of the box, reducing the volume of potential microbes getting into the box while also limiting gloves to be dispensed one at a time.
"This issue first came to my attention during a lab for one of my chemistry classes my first year at UConn," Quintana told UConn Today, the university's news hub. "No one could get just one glove out of the box, and there were gloves everywhere. We were told that once they fell out, we couldn't put them back; it was really wasteful."
A graduate assistant told Quintana that her workplace placed garbage cans under wall-mounted glove boxes to catch any extras.
"That got me thinking, why don't we stop this problem from happening and how could I redesign the glove box?" Quintana said.
Quintana connected with Christine Meehan, a nursing alumna and then-adjunct professor, to cultivate her idea. Meehan, a healthcare entrepreneur, led the school's innovations activities at the time.
Quintana applied for and was selected for UConn’s IDEA Grant Program, which awards funding to support student-designed and student-led projects.
She created an interdisciplinary team and worked with the School of Engineering’s Senior Design program to create prototypes and what she called "pull tests" to see how many gloves came out of the box with the prototype in place, according to UConn Today.
Because each prototype and round of testing led to adjustments, new prototypes, and more testing, Quintana added an independent study to her course schedule every semester since her first year, which allowed her to have time dedicated to developing her invention.
When Quintana planned to apply for a grant, she needed to add another team member to the application, and faculty member Tiffany Kelley paired her up with another innovation-leaning nursing student, Kelsey MarcAurele.
The two nursing students applied for, and received funding from, several innovation grants.
Despite the COVID-19 pandemic that emerged in early 2020, Quintana and MarcAurele continued refining and perfecting the invention and that summer, Quintana created a limited liability company, called RN Efficiently.
A year earlier, Quintana had applied for a standard patent in spring 2019. She recently was awarded that patent for ReduSeal.
Now that she has intellectual property and the patent, Quintana is looking for opportunities to license her product.
"I want to strategically license the product so hospitals can save money, reduce waste, and hopefully save time for nurses," she told UConn Today. "Nurses shouldn't have to clean up gloves."
Much of what she has learned from her project will serve her patients well when she goes to work this August as an emergency department RN at Hartford Hospital in Hartford, Connecticut.
"This process taught me problem-solving and critical thinking skills, when experiments didn’t go well, or I struggled to build prototypes," she said. "As an ER nurse, you have to know what resources are available to help your patients and now I can be the best advocate possible for them."
The health system sets up new RNs with experienced nurses—around the clock, if necessary.
Yale New Haven Health System (YNHHS), in New Haven, Connecticut, is boosting morale and increasing retention of new nurses by giving them a personal coach.
The Clinical Nurse Transition program is part of the health system's approach to help newly graduated RNs feel supported by setting them up with specially-chosen, experienced nurses who serve as personal coaches (PCs)—around the clock, if necessary.
Research has emphasized the importance of emotionally and professionally supporting newly graduated nurses, and that's what this program aims to do.
"It's at that juncture when the preceptor is no longer by their side, and they're brand new into practice," Ghidini says. "It's probably the most vulnerable time for new nurses."
"It also improves their organizational commitment, to the extent that they are more likely to remain in their job and keep working even under pressured circumstances," the study says.
New nurses are in the Clinical Nurse Transition program for at least a year, though they may remain for up to two years, depending on the length of their orientation and specialty. They'll spend that time under the guidance of experienced nurses who help them with clinical interventions, understanding policies, building rapport with patients, and anything else they need, Ghidini says.
The program was designed for coaches to oversee about 10 new nurses at a time, though that number is fluid, depending on hiring. They also work from 7 p.m. to 7 a.m. Monday–Friday and 24/7 on weekends, she says, "to cover the vulnerable times in the organization where there's not as much support."
Coaches and new nurse may be working in different units or buildings, but they can contact each other instantly via communication technology specifically designed for healthcare.
An influx of new nurses at Yale New Haven Health—from 132 in 2013 to more than 400 currently, Ghidini says—was a major impetus to start the program.
"We asked ourselves, 'how are we going to onboard and continue to retain these nurses?' and this was a modality to support that," she says.
They devised a coaching model with duties and key functions, which included:
Provide just-in-time coaching for development of critical thinking
Provide a safety net by identifying and resolving high-risk patient issues
Foster socialization to professional practice
Promote growth of new RN: prioritization; problem solving
Foster development of High Reliability Organizations (HRO) behaviors
Identification and resolution of high-risk patient situations; develop skills for escalation when needed
Inter-professional, patient and family communication and conflict management/service recovery
'They know they have a resource'
As one of Yale New Haven's coaches since 2019, Jimmy Esposito, RN, says the program allows new RNs to assess each situation more evenhandedly, knowing they have someone in the trenches with them to help if things go awry.
"They have a constant support system throughout the night shift, and they know that if they get into any kind of situation where they're uncertain or overwhelmed, they know they have a resource that they can rely on," he says. "And we can reinforce the standards of practice for the hospital, as well as be that mentor and emotional support for them."
One nurse, fairly new off orientation, requested Esposito's assistance with a bedside intubation.
"She's never been in any kind of situation yet [and] hasn't had the exposure yet to a critical situation with a patient decompensating to that degree," says Esposito, who has been a nurse for more than seven years. "It was an overwhelming situation, as you could imagine, to be present bedside for this intubation that happened quite quickly."
"As a coach in this role, you're able to literally stand right at the beside with this RN and support them through the process," Esposito says. "You can help remove them from certain aspects of the situation that might be too overwhelming to the point that they're not learning and they're unable to focus."
Esposito also backs up new RNs who work in the float pool and may be assigned to floors they're unfamiliar with or unsure of, he says.
"A nurse who normally works on an observation unit was floated to a medical unit that frequently has chest tubes and drains and she never had any experience with any drain care or chest tubes," he says. "They can be very overwhelming even to an experienced nurse if you don't see them frequently."
The nurse called Esposito, who is experienced with chest tubes, and as he stepped in to help, he saw panic disappear from the new nurse's face.
Choosing the right coaches
Coaches have been preceptors for at least two years but are also chosen for their particular skills and abilities, Ghidini says.
"We looked at not only at their clinical expertise but more so their communication skills," she says. "[They need] exceptional interpersonal skills and strong listening skills to be able to provide actionable, in-the-moment feedback," she says.
They also were chosen for their ability to solve problems, manage conflicts, organize priorities, and manage resources, as well as their triage skills, she says.
And while it appears the new nurses benefit the most from the program, the coaches themselves get a lot from it, too, Ghidini says.
"It really exposed them to other units and other areas of the organization, and they are able to share their knowledge, so it was very empowering for them, and it was a development piece for them," she says. "So, they love it as well."
Coaches also get a chance to make a greater impact throughout the health system, Esposito says.
"It allows you to serve as a professional role model. You're taking your experiences, and where you're normally making a difference on your units or within your six-patient assignment, you're now getting a little bit more of a global hospital perspective in covering up to 10 units at night," he says. "You're making, in my opinion, a larger scale difference, and you're able to help more people."
Esposito also finds satisfaction in helping new nurses grow and improve in their shared profession.
"The reward factor is a little greater because … you're fostering and nurturing the growth of this new grad while also providing high-quality care to the patient," he says. "And if you're in the role consistently the way I have been, you're actually able to see the growth of the new grad as their skill and their experience and their confidence picks up."
Positive outcomes
The year-and-a-half-old program is accomplishing what it was designed to do, Ghidini says, adding that a qualitative survey of the program taken by 422 respondents in various roles was highly positive.
Regarding new RN outcomes, the survey showed that the program:
Enhances RN confidence when caring for high-risk patients—75% agree or strongly agree
Eases RN transition from orientation to clinical practice—76% agree or strongly agree
Supports new RN transition from orientation to being an independent RN— 77% agree or strongly agree
Reduces RN stress levels when dealing with unfamiliar situations—73% agree or strongly agree
Regarding patient safety, the program:
Enhances patient safety by assisting RNs to identify when patients require immediate interventions or escalation of care—77% agree or strongly agree
Role models HRO behaviors—77% agree or strongly agree
Role models how to escalate care safely and effectively—75% agree or strongly agree
It's also had positive unintended outcomes, she says.
Charge nurses saw their workflow change for the better, because they previously were assigned to assist new graduates, Ghidini says.
"With our providers, it has greatly improved their satisfaction as well," she says, "particularly in critical situations or complex situations where they have an experienced nurse there to support and help with the patient at the bedside in conjunction with the newer nurse."
And when COVID-19 began overwhelming healthcare staffs last year, the already-established coaching program sustained the new nurses.
"It really supported us during that COVID time with all of the unanswered questions and the uncertainty, so this role really took on an emotional support during that time for the nurses," Ghidini says. "They fortunately had already established trusting relationships out there."